Zika virus and pregnancy concerns have made news headlines for weeks. Doctors are inundated with calls and questions about the Zika virus, pregnancy, microcephaly, Guillain-Barré syndrome, and travel to warm climates. Zika is said to be sexually transmitted. Women are afraid to procreate and are advised to wait two years before attempting pregnancy. But is it really mosquitoes and the virus we should be afraid of? Or is there something else in the proverbial water?

Zika Virus Facts

The Zika virus was discovered in Uganda in 1947. It is primarily transmitted to humans via the bite of the infected Aedes aegypti mosquitoes. This is the same mosquito that transmits dengue, chikungunya and yellow fever. The virus can also be transmitted by a pregnant woman to her fetus, through sexual contact, and through blood transfusions. Most people do not become sick. About 20% (or 1 in 5) experience a mild illness of fever, rash, joint pain or conjunctivitis that lasts several days to a week. Zika virus disease is usually relatively mild and requires no specific treatment. There is currently no vaccine available.

From an illness standpoint, we need to be far more worried about contracting dengue, chikungunya, and yellow fever from those pesky mosquitoes than the Zika virus.

Zika Virus and Pregnancy

According to the National Institutes of Health (NIH), “there have been reports of a serious birth defect of the brain called microcephaly among babies born to mothers infected with Zika virus during pregnancy. Currently, it is unclear what link if any Zika infection may have to microcephaly. International research organizations are investigating.” Also, there have been “reports of Guillain-Barré syndrome (GBS) in some countries where Zika transmission is occurring. Most people do recover from GBS, but some have permanent damage and, in rare cases, GBS leads to death. It is not known if Zika virus infection causes GBS, and the U.S. Centers for Disease Control and Prevention (CDC) is working to answer this important question.”

The World Health Organization (WHO) states “Although not proven, researchers are studying a potential link between microcephaly cases and Zika virus infection.

The Centers for Disease Control (CDC) weighs in on the question regarding anyassociation between Zika virus infection and congenital microcephaly: “Studies are under way to investigate the association of Zika virus infection and microcephaly, including the role of other contributory factors (e.g., prior or concurrent infection with other microorganisms, nutrition, and environment).”

The European Centre for Disease Prevention and Control addresses the Zika virus: “A significant increase of patients with Guillain–Barré syndrome (GBS) was reported during the 2014 outbreak in French Polynesia and the Americas since 2015. A similar increase along with an unusual increase of congenital microcephaly was observed in some regions in north eastern Brazil in 2015. Causal relationships are currently under investigation.”

Don’t Jump to Conclusions

There is an outbreak of the Zika virus in certain geographical areas. There is also a rise in the number of babies born with microcephaly to pregnant women infected with the virus and a rise in cases of Guillain-Barré syndrome in these areas. Does this mean the Zika virus is the culprit? No. There is no basis in fact, no evidence-based medicine, no research to prove the hypothesis. Could it be the cause? Sure. But nobody knows.

Let’s say everybody in my family ate apples after dinner. We all fell ill that night. Obviously, the apples made us sick – it was the common denominator. You could postulate that and believe it to be true. But did the apples make us sick? Or was it salmonella left behind in the kitchen when somebody failed to clean up properly and transferred it to the apples. Were the apples washed? But wait…what about the water the apples were washed in?

What’s in the Water?

An Argentine organization called Physicians in the Crop Sprayed Towns issued a report questioning the theory that Zika virus is responsible for the increase in neurological problems (microcephaly, Guillain-Barré) in Brazil. The physicians make valid points and suggest chemicals added to the drinking water are responsible, not the Zika virus.

Mosquitoes carrying the Zika virus breed in water. The water is treated with chemicals to eliminate the mosquito population and therefore transmission of Zika, dengue, chikungunya and yellow fever. Pregnant women drink the water. Could the chemicals in the water be causing microcephaly and Guillian-Barré syndrome?

The report states previous Zika epidemics around the world did not cause defects in newborns, despite 75% of the population being infected. Also, in other countries such as Colombia there are no records of microcephaly; however, there are plenty of Zika cases.

“A dramatic increase of congenital malformations, especially microcephaly in newborns, was detected and quickly linked to the Zika virus by the Brazilian Ministry of Health. However, they fail to recognize that in the area where most sick persons live, a chemical larvicide (pyroproxyfen) was used to treat the drinking water of the affected population for the previous 18 months” the physicians group reported. The report goes on to link the chemical companies with policy makers, alluding to collusion.

Another organization, Abrasco (Brazilian doctors’ and public health researchers’ organization) issued a report (Google will translate) concurring with the Argentine physicians. Abrasco also names the same chemical as a likely cause of the microcephaly. It condemns the strategy of chemical control of Zika-carrying mosquitoes, which it says is contaminating the environment as well as people and is not decreasing the numbers of mosquitoes. Abrasco suggests that this strategy is in fact driven by the commercial interests of the chemical industry, which it says is deeply integrated into the Latin American ministries of health, as well as the World Health Organization and the Pan American Health Organization.

Who Benefits From What?

The Zika scare has financial and political ramifications. Big money is involved all around. Research, vaccine development and sales, insect repellent, etc. – companies stand to make fortunes feeding on the perceived threat. Chemical companies making the larvicide to kill off the mosquito population and the companies contracted to distribute and implement the plans stand to benefit.

Better Safe Than Sorry

Is the Zika virus dangerous for pregnant women, or for women who plan to procreate in the near term? Who knows? But better be safe than sorry. Reconsider travel, protect against mosquito bites, don’t drink the water, and better yet, stay home. Condoms prevent sexual transmission of Zika and many other STDs (are we calling Zika an STD now?). Protect yourself, not just from Zika, but from all the other diseases mosquitoes carry.

I did it. I called out sick. Besides the chills wracking my body, I am also wracked with guilt. Nurses aren’t supposed to call out sick. We care for the sick. We don’t do illness ourselves. And calling out sick is practically sinful.

Our benefits package includes paid time off for illness or disability. But we’re not supposed to use more than a day or two a year (and only if dying). It’s the cultural norm for healthcare workers to work despite illness. So I kept working for weeks when I should have stayed home, blaming every sneeze on those damn allergies.

When I read this post on the blog Florence is Dead, I couldn’t help but laugh. I blamed the sneezing, running nose, watering eyes, headache, and cough on my “allergies” for months. It was a warm November and December in New Jersey, so it seemed plausible to pass off my symptoms as allergies. That’s what I told myself. Because I am a nurse, and nurses don’t get sick.

But now it is January and the weather is frigid. The chance that pollen is traveling on the wind up to NJ is nil. So I must be sick, but . . .

Not Sick Enough for Calling out Sick

I wasn’t that sick when the symptoms started. But it isn’t acceptable to enter a patient’s room and sneeze, blow, and cough (“sorry, my allergies are really bad today”). So I had to stop the symptoms.

It was the medicines I took to cover up my sneezing, plugged nose and sinuses that did me in.

When the Allegra and neti pot weren’t enough, I added Afrin and Tylenol, then Sudafed, then Benadryl. After a week or so, they didn’t work as well and I had to use them more often. By then I had my original symptoms plus rebound if I didn’t use them – a vicious cycle that is hard to break. I purchased so much Sudafed the pharmacist came over to talk with me, suspicious I was cooking crystal meth. Then he said I had to get a family member to come in and buy it, because I’d exceeded the legal limit for the month.

Meanwhile, Afrin and Sudafed raised my blood pressure, elevated my heart rate, and caused insomnia. Sinus tachycardia became my norm (just ignore the chest pain). I tried not to think about my blood pressure. My nose bled every time I had to blow (and I had to do that often, just to breathe). The medications caused decreased peristalsis (I don’t even want to mention what happens when you have a GI backup and a forceful sneeze comes from your toes out your nose) and urinary retention. Bloating was uncomfortable and the edema from urinary retention made it hard to breathe. Let’s just say I was somewhere between seven and eight:

Being a nurse and all, I know the color should be above the red line. So I drank more, retained more, and drank some more. Still dehydrated, my skin went from dry to parchment paper. I had a raw, red ring around my nose and my lips were chapped. The bags under my eyes went from carry-on to steamer trunk. My throat was dry and the sinus drip made me cough, which set off bronchospasm (I have asthma), but I was afraid to use my inhaler because my heart was already pounding away at 120 bpm already (so says my Fitbit Charge HR). I asked for a pulse oximeter for Christmas (thank you, Ken) to make sure my shortness of breath wasn’t too short.

Work

I still went to work, 13 hours shifts in labor and delivery, hoping I wouldn’t have to push with a patient for a long time (how would I blow my nose?). Thankfully, my patients all delivered in record time, or didn’t deliver, if that was the goal (I love my ante-partum patients!).

My symptoms became uncontrollable, but I did my best to hide it. After all, it was just allergies, or at worst a cold. And my patient was trying her hardest to die on me, and I was trying harder not to let her. How could I complain about my tachycardia when hers was life-threatening at 180+ bpm? Or that my nose was bleeding, again, when I was hanging multiple blood products to keep her alive? Taking care of her, I felt guilty for even thinking I was sick, when she was walking the fine line.

This Leads to That

Well, if you retain a seven to eight color for too long, the inevitable happens. Can anybody say UTI? Working a 13 hour nursing shift with no time to use the restroom, the UTI put me over the edge. I did the unthinkable.

Calling out Sick

I should have done it months ago instead of waiting until I was so sick it would take me days to feel better. But just picking up the phone to call the staffing office made me quake in my Danskos. I know how hard it is to staff a unit. I know how hard it is to work short. We all hate it and now I’d done it to the other nurses. Sick, in bed and browsing stuff on my iPad, I was reminded of why I felt guilty.

The Facebook plea for help was out, and I was responsible for my coworkers having a crap day. To be fair, it is the fastest way to reach any available nurse. But it didn’t help the guilt I was already feeling. It’s the kind of guilt that rivals what you get from an Italian mother and the Catholic church.

However, the deed was done and I had to make the best of it. Cipro for the UTI and the neti pot whenever I needed it. The rest I dropped cold turkey, and waited for the rebound to subside. Mostly I slept and drank tea, with a hot toddy at night to help me sleep.

The next time a nurse calls out sick and we’re working short, I won’t complain. Because I know how hard it is to pick up the phone and do it, and just how sick that nurse must feel to need to do the unthinkable: call out sick.

No Sick Time Allowed! Doctors and Nurses Work While Sick.

No sick time for medical personnel

Do doctors and nurses work while sick? Yes, we work while we are sick. Why? We’re not allowed to take sick time. We take care of sick people, but are not permitted to be out sick ourselves. This isn’t written in any policy, but it is the understood law of the land.

Recent findings published this week in JAMA Pediatrics confirm what I already know – doctors, nurses and other medical professionals work while sick. Here is a summary of the survey:

The purpose of this study was to understand how frequently and why attending physicians and advanced practice clinicians work while sick.

Ninety-four percent of respondents believed that working while sick puts patients at risk.

Despite recognizing the risk, 446 respondents (83.1%) worked sick at least once in the past year, with 50 (9.3%) reporting having worked sick more than 5 times in the past year.

Primary reasons why respondents work sick included not wanting to let colleagues and patients down, extreme logistic challenges in finding coverage, a strong cultural norm to work through sickness, and ambiguity about what constitutes too sick to work.

Over the last thirty years, I’ve worked at several hospitals and out-patient settings. The pressure to work while sick was the same. It is not specific to one employer. While “sick time” is included in benefits packages, healthcare workers are discouraged from using it. It is the cultural norm.

What constitutes too sick to work? If you can’t stand up, you can’t work. But we’ll do everything we can to keep you standing. If you can stand on one leg (as in a recent case of a healthcare worker with a broken foot) and use a scooter for the other, you can work.

Fever? Dehydration? Nausea? Vomiting? Diarrhea? Headache? Cough? No problem. Doctors and nurses help each other to keep going. Just start an IV line, run in some fluids for the fever and dehydration, push an anti-emetic for the nausea, then take a few Imodium to stop the runs. Swallow Robitussin. Add IV Tylenol or a couple of tablets and we’re cured (or at least covered up the symptoms). Cap off the IV and leave it in for use later in the day when the medications wear off. Cover with a sleeve long enough to hide the IV site. We don’t want the patients to know we are sick.

Why don’t we take sick time off? We can’t. Doctors have obligations. Patients don’t want to hear their surgery is cancelled or a physician they don’t know will perform it instead. Patients don’t want to have their long awaited appointment cancelled because the provider doesn’t feel good. Resident physicians have to put in a minimum amount of hours to graduate. Taking sick time eats into the few weeks of vacation they can take. And getting somebody to cover a long shift is problematic. Nurses generally work thirteen hour shifts, many times short on staff already. Somebody has to cover those thirteen hours – that is if you can find a nurse who isn’t already burned out or sick, too. We also feel the obligations to our coworkers and patients.

Working while sick is our cultural norm. We don’t want to let down our patients or our coworkers. We’ll keep each other going, because calling out up is not an option.

Is it right? Not really. We shouldn’t put our patients at risk by working sick. We’re not at our best when sick, but we are obliged to function perfectly for patient safety, and it is exhausting to do so in the face of illness. We shouldn’t expose our patients to potential contagions, either, such as the flu (you did get your flu shot, didn’t you?).

But our patients come first, and we’ll put ourselves at risk to care for them. Because somebody has to do it, and we’re it.